Mental health policy and practice across Europe: an overview

The user and survivor movement 347
into one of the social care homes, Hrastovic, and then opening the first
community-based group home (with pump priming from Hamlet Trust’s grant
programme) for three people who had lived there for many years. These three
now live quiet and contented lives in the community, but unfortunately the
development of further group homes never took off. While there are now
around 35 group homes in Slovenia, they only cater for people with short-term
problems and until recently no one else had moved out of institutional care. As
a mental health professional said, ‘We seem to have lost the compass of user
involvement here’. However, Hrastovic is now undergoing a complete transformation
and many former residents now live, and sometimes work, in the
community. One area where there is perhaps a better opportunity for change is
in Bosnia and Herzegovina. The situation in this war-torn country is fairly
unique, as many of its institutions were destroyed. Mental health services are
now being rebuilt around a community alternative and, again with the help of
the Hamlet Trust, the first user group was established in 1999. There are now
seven groups meeting in different cantons in the country.
The issues that are, in a sense, unique to this part of Europe are as follows, and
while they have a unique profile in each country, there are some common
features:
• the impact of the Soviet system – primarily institutionalization and passivity
or complete reliance on professionals, and above all, an assumption that
people are better off in institutions;
• the impact of the abuse of psychiatry;
• the impact of immense social, cultural and political upheaval;
• the fact that each country’s economy took a major downturn and they all
experienced some kind of inflation, so that money to run services has been
severely limited; and
• the influence of the World Bank and International Monetary Fund, which
have insisted on the development of market economies, shifting each
government’s focus away from social developments.
Are groups user-controlled?
It is not enough just to describe the activities in which user/survivor groups
are involved. The fundamental principle underpinning all of these activities is
that users should have more control over their lives, both individually and
collectively. This is still mostly a novel idea as traditionally nearly all aspects of
users’ lives were controlled by mental health professionals or by the state.
As mentioned earlier, we asked groups to indicate whether or not they were
user-controlled, but many could not make sense of this question. We believe
this indicates that they are not, in fact, user-controlled. There are wide discrepancies
in western European countries on this issue. An example of a national
group wholly user-controlled is Clientenbond in the Netherlands. On the other
hand, in Austria, many local user groups are organized by Pro Mente, a non-user
controlled NGO and mental health service provider.
In the West, there seem to be two historical trajectories at work exemplified by